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Integrated Care for Older People: Management and

Policy Issues

Henk Nies, PhD

NIZW, The Netherlandswww.carmen-network.org

h.nies@nizw.nl

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Presentation

The CARMEN network Case/vignette The concept of integrated care Who cares? Who pays? Who decides? Issues to be addressed

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CARMEN: the actors

Users Carers Primary care Acute hospitals Care homes

Social care Purchasers Researchers Consultants Other

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CARMEN: the countries

Belgium Finland Germany Greece Ireland

Italy The Netherlands Spain Sweden UK

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Mrs Costa

78 years widow dementia migrated cleaning women 3 children 1 child abroad

poor contacts minimum old age

pension discharge after mild

stroke difficulties in moving in

the house disagreement children

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Traditional (e.g. questionnaires, reviews)

Descriptive (e.g. structured analyses, cases)

Qualitative (e.g. vignettes)

Internal inputs (subgroups, plenary sessions)

External inputs (e.g. experts’ presentations

MethodsMethods

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‘‘AA well planned and well organised set well planned and well organised set of services and care processes, of services and care processes, targeted at the multiple needs/targeted at the multiple needs/ problems of an individual client, problems of an individual client, or a category of persons with similar or a category of persons with similar needs/problems’needs/problems’

Integrated care (Vaarama, 2001)

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Integration (Leutz, 1999)

Linkage

Co-ordination

Full integration

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Who cares?

Professionals ánd informal carers Threats:

demographylow statusgeographic mobility

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Who cares?

Complicationsqualifications incomparable and

incompatiblewho cares in the homeland?immigrant and refugees as a resource

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Who cares?

Prospectsmore effective use of staffless duplicationflexible employmentjob enrichmentnew rolesless demand

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Who pays? Diversity in long term care:

servicesagencieslocal communityold people themselveslegislative frameworkspolicy levelsprofessional cultures

fragmentation

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Who pays?

Complicationsimbalances in the systemcoverageinter-dependency of health care and social

care, housing, transport etccash benefits: more providers‘buyers power’entitlement of citizens abroad

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Who pays?

Solutions?

debate on Services of General Interest strengthening the voice of older people

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Who decides?

Supply driven systems Final responsibility fragmented: good will Mergers: no choice, no competition,

better integration? Assumptions underlying benefits in cash,

underlying the market mechnisms Buyers power Older people themselves

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Issues to be addressed

Qualifications of staff, new professionals Balance of new mobility Accessibility, quality and financial

sustainability in the internal market Care for older people outside country of

origine Empowerment of older people